Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942010000600011
Brazilian Journal of Anesthesiology
Review Article

Hiperalgesia induzida por opioides (HIO)

Opioid-induced hyperalgesia (OIH)

Plínio da Cunha Leal; Jefferson Clivatti; João Batista Santos Garcia; Rioko Kimiko Sakata

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Resumo

JUSTIFICATIVA E OBJETIVOS: Opioides são medicamentos frequentemente usados para o controle da dor que, contudo, podem causar hiperalgesia. A circunstância pela qual esse fenômeno pode ocorrer não está inteiramente esclarecida. O objetivo desta revisão foi descrever os mecanismos, os fatores implicados e a modulação por medicamentos. CONTEÚDO: Foram descritos os fatores implicados no desenvolvimento da hiperalgesia induzida por opioides (HIO), como duração de uso, dose e tipo de opioide. Os mecanismos incluem o sistema glutamatérgico e receptores N-metil-D-aspartato (NMDA), ativação de ciclo-oxigenase (COX) espinal, aminoácidos excitatórios, dinorfina, citocinas e quimocinas; prostaglandinas e facilitação descendente. A modulação de hiperalgesia pode ser feita com antagonistas de receptores NMDA, agonistas adrenérgicos-alfa2 e inibidores de COX. CONCLUSÕES: O assunto é bastante complexo, envolvendo uma série de mecanismos fisiopatológicos que podem contribuir para a HIO e o desconforto do paciente, trazendo consequências que podem ser danosas.

Palavras-chave

ANALGÉSICOS, COMPLICAÇÕES

Abstract

BACKGROUND AND OBJECTIVES: Opioids are commonly used for pain control; however, they can cause hyperalgesia. The reason why this can happen is not known. The objective of this review was to describe the mechanisms, factors implicated, and drug modulation. CONTENTS: The factors implicated in the development of opioid-induced hyperalgesia (OIH), such as duration of use, dose, and type of opioids are described. Mechanisms involved include the glutamatergic system and N-methyl-D-aspartate receptors (NMDA), spinal cyclooxygenase (COX) activation, excitatory amino acids, dynorphin, cytokines and chemokines; prostaglandins, and descending facilitation. Modulation of hyperalgesia could be done through: NMDA receptor antagonists, alpha2-adrenergic agonists, and COX inhibitors. CONCLUSIONS: This is a very complex subject, which involves a series of pathophysiological mechanisms that could contribute for OIH and patient discomfort, bringing disastrous consequences.

Keywords

ANALGESICS, COMPLICATIONS

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